Having your menstrual period can come with annoying and uncomfortable symptoms such as bloating, painful cramps, constant tummy aches, and frequent bathroom visits. But for those with inflammatory bowel syndrome (IBS), the symptoms can be worse, from the start of your period and throughout the menstrual cycle.
Having IBS appears to put individuals at an increased risk of experiencing menstruation-associated symptoms such as dysmenorrhea (painful cramps), backaches, concentration difficulties, insomnia, fatigue, and water retention.
The reason could be the association between your gut and the way the reproductive system functions during menstrual cycles.
Sex hormones fluctuate during different phases of the menstrual cycle. Estrogen is at its peak just before ovulation, while progesterone is at its peak during the luteal phase- the phase between ovulation and menstruation onset. But these hormones drop to the lowest levels just before the beginning of the menstrual period.
During your period, hormones affect more than just your energy levels and mood-they can boss your gastrointestinal system around. There are estrogen and progesterone receptors throughout the gastrointestinal (GI) tract. Both the female sex hormones control smooth muscle contractions in the intestines, affecting gut motility or how quickly food travels in the GI tract.
Therefore, individuals, even those without IBS, can experience gastrointestinal symptoms such as abdominal pain, nausea, and diarrhea in days just before menstruation (pre-menstrual) and for the initial one or two days of menstruation. Immediately following ovulation, when progesterone is at its peak, individuals are more likely to experience constipation and bloating.
In a study published in Cureus in 2021, more than 50% of patients with IBS experienced bloating during all phases of their menstrual cycle. In the premenstrual phase, IBS patients had more symptoms during their period that affected routine activities and lowered their quality of life compared to other stages of the menstrual cycle.
A study published in Neurogastroenterology Motility in 2021 reported that lower levels of estrogen and progesterone may affect brain-gut interactions and heighten IBS symptoms.
In addition, every month before your period, the body releases chemicals known as prostaglandins, which trigger the muscles in the uterus to contract, making it easier to shed the uterine lining. The chemicals can have the same effect on bowel movements, resulting in increased frequency of stools and diarrhea.
Body systems are more reactive to gassy foods in the days surrounding menstruation.
The link between estrogen and gut health
The liver deactivates active estrogen that has been transported from the ovaries. Subsequently, the deactivated estrogen exits the liver through the bile and enters the small intestine via estrogen receptors, which are home to the microbiome. Gut bacteria produce an enzyme that interacts with estrogen before its excretion.
If the gut microbiome is altered, estrogen might not metabolize properly. Excess harmful gut bacteria (dysbiosis) may increase estrogen levels by preventing the liver from breaking down excess estrogen. Thus, estrogen could return to the bloodstream, and cause gastrointestinal issues such as constipation and bloating, in addition to menstrual symptoms such as uterine fibroids, heavy periods, painful periods (dysmenorrhea) and breast cancer, with altered bowel habits.
Elevated estrogen levels can cause tumour-like cell overgrowth in the uterine lining, resulting in pain and endometriosis. Altered gut health can also contribute to pregnancy complications and disorders like polycystic ovarian syndrome among other reproductive-related conditions.
There’s evidence, too, that low sex hormone levels could also increase the severity of pain and GI symptoms in IBS patients during their monthly cycle. Estrogen affects how the body uses the feel-good hormone serotonin, which raises the pain threshold to help manage menstrual cramps.
As female sex hormone levels drop, GI symptoms such as constipation, bloating, cramps and bowel movements increase. IBS patients already suffer from the GI symptoms associated with menstrual periods, so when periods arrive, the severity of these symptoms goes through the roof.
How to Manage Your Symptoms
- You can start by keeping a symptom diary. Just keep a running record of your symptoms as it relates to which phase you are in your menstrual cycle. This will allow you to identify patterns and times during which your symptoms are likely to be at their worst.
- Having an idea of what to expect on each day of your menstrual cycle can help you to plan. You may tweak your diet by choosing non-gassy foods on your worst days.
- You can also try to adjust your schedule by postponing events that may be more stressful to days when your symptoms are more likely to be less severe.
- Invest in a heating pad or hot water bottle. Continuous heat can soothe IBS pain and ease menstrual cramps.
- Consider calcium supplements. Calcium supplements particularly help individuals who experience diarrhea as part of IBS and can reduce menstruation-related symptoms.
The Bottom Line
Menstruation-associated hormones interact with the gut to cause several symptoms. IBS symptoms can exacerbate during menses.